Almost three-quarters of <a href="https://healthylife7.com/duchenne-muscular-dystrophy-patients-are-focus-of-glp/” title=”Duchenne muscular dystrophy patients are focus of GLP”>patients undergoing metabolic bariatric surgery met proposed criteria for clinical obesity, while more than one-quarter had preclinical disease despite similar body mass index (BMI) distributions, according to a recent study, suggesting that systematic assessment of obesity-related organ dysfunction could improve patient prioritisation
Last year, The Lancet Diabetes and Endocrinology Commission proposed distinguishing clinical from preclinical obesity by establishing formal definitions as part of a new framework shifting diagnosis beyond body size alone towards its demonstrable effects on health
As such, clinical obesity was defined as organ dysfunction or impaired daily functioning attributable to excess adiposity, while its preclinical counterpart was defined as the presence of excess adiposity, but with preserved organ function
Now, researchers have retrospectively applied the criteria to 2,316 adults who underwent primary laparoscopic gastric bypass or sleeve gastrectomy between 2014 and 2025 at four tertiary centres in the UK, Spain, France and Brazil
Published in JAMA Network Open, they assessed the prevalence of clinical and preclinical obesity, patterns of organ dysfunction, BMI, baseline disease and perioperative risk, and postoperative outcomes
Clinical and preclinical obesity were compared within individual cohorts, with no direct statistical comparisons between centres
Clinical obesity and disease burden
Overall, 1,709 patients (73.8%) met the criteria for clinical obesity and 607 (26.2%) were found to have preclinical. Clinical obesity was the predominant category at every centre, ranging from 62.7% of patients in the Brazilian cohort to 79.3% in the UK cohort
BMI did not distinguish the two groups. Mean BMI ranged from 40.2 kg/m² among patients with preclinical obesity in Brazil to 48.5 kg/m² among that group in the UK. Neither BMI levels nor BMI category distributions differed significantly between clinical and preclinical within individual centres
Patients with clinical obesity were consistently older and had higher scores on the American Society of Anaesthesiologists Physical Status Classification System across all four cohorts
Charlson Comorbidity Index scores were also higher in the UK, Spanish and Brazilian cohorts, while Framingham risk scores were higher in the Spanish, French and Brazilian cohorts for which these data were available
Among patients with clinical disease, the most common obesity-related dysfunctions included hypertension, metabolic dysfunction, sleep apnoea requiring continuous positive airway pressure and functional or musculoskeletal limitation, although prevalence varied substantially between centres
Bariatric surgery risk and outcomes
Major 30-day postoperative complications were significantly more frequent among patients with clinical obesity than those with preclinical in the French cohort (4.0% vs 1.1%; P=0.04). Differences were smaller and not statistically significant in the UK and Spanish cohorts, while complication data were unavailable for Brazil
Postoperative weight loss was generally lower among patients with clinical obesity, with statistically significant differences at selected follow-up points in the Spanish, French and Brazilian cohorts
The authors said that applying the Commission’s proposed criteria retrospectively required pragmatic adjudication using existing clinical records. They also cautioned that differences in clinical documentation and assessment between centres could have affected classification, while the audit design prevented definitive attribution of individual organ dysfunctions to obesity
Potential selection bias could also not be fully quantified in the UK and Brazilian cohorts, they added
The authors concluded that obesity status could not be inferred from BMI alone and suggested that distinguishing clinical from preclinical could improve characterisation of bariatric surgery candidates and treatment prioritisation
They also proposed that surgical services should systematically assess obesity-related organ dysfunction when evaluating patients
ReferenceCremona S et al. New Obesity Definition and Clinical Obesity Prevalence for Global Metabolic Bariatric Surgery. JAMA Netw Open 2026;9(8):e2628395
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